Predisposing Factors: Precipitating Factors:

AGE Excessive alcohol

consumption
SEX
Hypertension
RACE

GENETICS

Occlusion of artery

Decreased blood flow

Decreased
Medical Management Surgical oxygenation
Managementand Nursing Management
 Anticonvulsants - To nutrition to brain
 Ventriculostomy  Stabilization of vital
prevent seizure signs
recurrence  Evaluate pupils, noting
 Antihypertensive agents size, shape, equality,
- To reduce BP and light reactivity.
other risk factors of  Maintain bed rest,
heart disease provide quiet and
 Osmotic diuretics - To relaxing environment,
decrease intracranial restrict visitors and
pressure in the activities. Cluster
subarachnoid space nursing interventions
and provide rest
periods between care
activities. Limit duration
of procedures.
 Position with head
slightly elevated and in
neutral position

Decreased energy stores

Increased glutamine and

aspartate

Open Ca channels

Increase Ca, Na and Cl

Decreased K

Increased cell death

DATE PERFORMED: February 12, 2020

TIME PERFORMED: 04:40 AM

HEMATOLOGY SECTION

TEST NAME RESULTS UNIT REFERENCE RANGE SIGNIFICANCE

Complete Blood Count increased production of

WBC COUNT 11.19 H X1O^9/L 4.4-11.0 white blood cells to fight an
infection.
RBC COUNT 3.73 L X10^12/L 4.5-5.9
measures in these three
HEMOGLOBIN 115.00 L g/L 140-175
areas are lower than
HEMATOCRIT 34.100 L % 41.5-50.4 normal,patient have anemia.
Anemia causes fatigue and
MCV 91.40 fl 80-96 weakness due to an
MCH 30.80 pg/cell 27.5-33.2 underlying condition.

MCHC 33.70 % 33.4-35.5

RDW-CV 15.00 H % 11.50-14.50

PLATELET COUNT 451.00 H X10^9/L 150-450 A platelet count that's lower

than normal
Differential Count
(thrombocytopenia) or
NEUTROPHIL 71.40 H % 55-65 higher than normal
(thrombocytosis) is often a
LYMPHOCYTE 11.30 L % 25-35 sign of an underlying
MONOCYTE 16.00 H % 3-11 medical condition, or it may
be a side effect from
EOSINOPHIL 0.80 L % 2-4 medication.
BASOPHIL 0.50 % 0-1

CHEMISTRY SECTION

TEST NAME RESULTS UNIT REFERENCE RANGE SIGNIFICANCE

Blood Urea Nitrogen H 26.05 mg/dl 7.87-20.25

 Increased BUN
Creatinine H 1.55 mg/dl 0.8-1.3 levels suggest
impaired kidney
SGOT/AST H 279.01 U/L 0.0-35.0
function.
SGPT/ALT H 174.32 U/L 0-45  a high creatinine
level may mean
your kidneys are not
working properly.
 Indicates liver
damage
 Discharge Plan
Medicines:

You may need any of the following:

 Antiplatelets , such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly
as directed. These medicines make it more likely for you to bleed or bruise. If you are told to
take aspirin, do not take acetaminophen or ibuprofen instead.

 Blood thinners help prevent blood clots. Examples of blood thinners include heparin and
warfarin. Clots can cause strokes, heart attacks, and death. The following are general safety
guidelines to follow while you are taking a blood thinner:

o Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from
your gums or nose. Watch for blood in your urine and bowel movements. Use a soft
washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your
skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact
sports.

o Tell your dentist and other healthcare providers that you take anticoagulants. Wear a
bracelet or necklace that says you take this medicine.

o Do not start or stop any medicines unless your healthcare provider tells you to. Many
medicines cannot be used with blood thinners.

o Tell your healthcare provider right away if you forget to take the medicine, or if you take
too much.

o Warfarin is a blood thinner that you may need to take. The following are things you
should be aware of if you take warfarin:

o Foods and medicines can affect the amount of warfarin in your blood. Do not
make major changes to your diet while you take warfarin. Warfarin works best
when you eat about the same amount of vitamin K every day. Vitamin K is found
in green leafy vegetables and certain other foods. Ask for more information
about what to eat when you are taking warfarin.

o You will need to see your healthcare provider for follow-up visits when you are
on warfarin. You will need regular blood tests. These tests are used to decide
how much medicine you need.

 Medicines may be given to treat health conditions that increase the risk for a stroke. Examples
are high cholesterol, high blood pressure, and diabetes.

 Take your medicine as directed. Contact your healthcare provider if you think your medicine is
not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a
list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you
take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in
case of an emergency.

Environment:

 Make your home safe. Remove anything you might trip over. Tape electrical cords down. Keep
paths clear throughout your home. Make sure your home is well lit. Put nonslip materials on
surfaces that might be slippery. An example is your bathtub or shower floor. A cane or walker
may help you keep your balance as you walk.
Treatment:

Determining the cause of the bleeding.

●Controlling the blood pressure.

●Stopping any medication that could increase bleeding (eg, warfarin, aspirin). If the patient has been
taking warfarin, specific treatments such as factor VIIa or transfusions of blood clotting factors, may be
given to stop ongoing bleeding.

●Measuring and controlling the pressure within the brain.

Pressure within the brain can be measured by placing a device, known as a ventriculostomy tube,
through the skull into an area of the brain called the ventricle. If the pressure is elevated, a small
amount of cerebrospinal fluid can be removed from the ventricle. A ventriculostomy can also be used to
drain blood that has collected in the brain as a result of the stroke. The procedure can be done at the
patient's bedside or in an operating room.

Health Teachings:

 Manage health conditions. A condition such as diabetes can increase your risk for a stroke.
Control your blood sugar level if you have hyperglycemia or diabetes. Take your prescribed
medicines and check your blood sugar level as directed.

 Check your blood pressure as directed. High blood pressure can increase your risk for a stroke.
If you have high blood pressure, follow your healthcare provider's directions for controlling it.

 Do not use nicotine products or illegal drugs. Nicotine and other chemicals in cigarettes and
cigars can cause blood vessel damage. Nicotine and illegal drugs both increase your risk for a
stroke. Ask your healthcare provider for information if you currently smoke or use drugs and
need help to quit. E- cigarettes or smokeless tobacco still contain nicotine. Talk to your
healthcare provider before you use these products.

 Talk to your healthcare provider about alcohol. Alcohol can raise your blood pressure. The
recommended limit is 2 drinks in a day for men and 1 drink in a day for women. Do not binge
drink or save a week's worth of alcohol to drink in 1 or 2 days. Limit weekly amounts as directed
by your provider.

 Eat a variety of healthy foods. Healthy foods include whole-grain breads, low-fat dairy products,
beans, lean meats, and fish. Eat at least 5 servings of fruits and vegetables each day. Choose
foods that are low in fat, cholesterol, salt, and sugar. Eat foods that are high in potassium, such
as potatoes and bananas. A dietitian can help you create healthy meal plans.

 Maintain a healthy weight. Ask your healthcare provider how much you should weigh. Ask him
or her to help you create a weight loss plan if you are overweight. He or she can help you create
small goals if you have a lot of weight to lose.

 Exercise as directed. Exercise can lower your blood pressure, cholesterol, weight, and blood
sugar levels. Healthcare providers will help you create exercise goals. They can also help you
make a plan to reach your goals. For example, you can break exercise into 10 minute periods, 3
times in the day. Find an exercise that you enjoy. This will make it easier for you to reach your
exercise goals.

 Manage stress. Stress can raise your blood pressure. Find new ways to relax, such as deep
breathing or listening to music.

Observable Cues/Out-Patient:

Call 911 right away if you have any of the following symptoms of stroke:

 Weakness, tingling, or loss of feeling on one side of your face or body

 Sudden double vision or trouble seeing in one or both eyes

  Sudden trouble talking or slurred speech

 Trouble understanding others

 Sudden, severe headache

 Dizziness, loss of balance, or a sense of falling

 Blackouts or seizures

 Keep your medical appointments. Close follow-up is important to stroke rehabilitation and recovery.

 Some medications require blood tests to check for progress or problems. Keep follow-up
appointments for any blood tests ordered by your doctors.

Diet and Exercise:

 Take your medications exactly as directed. Don't skip doses.

 Your health care provider will give you information on dietary changes that you may need to
make, based on your situation. Your provider may recommend that you see a registered
dietitian for help with diet changes. Changes may include:

o Reducing fat and cholesterol intake

o Reducing sodium (salt) intake, especially if you have high blood pressure

o Increasing your intake of fresh vegetables and fruits

o Eating lean proteins, such as fish, poultry, and legumes (beans and peas) and eating less
red meat and processed meats

o Using low-fat dairy products

o Using vegetable and nut oils in limited amounts

o Limiting sweets and processed foods such as chips, cookies, and baked goods.

 Begin an exercise program. Ask your doctor how to get started and how much activity you
should try to get on a daily or weekly basis. You can benefit from simple activities such as
walking or gardening.

 Limit alcohol intake. Men should have no more than 2 alcoholic drinks a day. Women should
limit themselves to 1 alcoholic drink per day.

 Know your cholesterol level. Follow your doctor's recommendations about how to keep
cholesterol under control.

 If you are a smoker, it is time to quit now. Enroll in a stop-smoking program to improve your
chances of success. Ask your doctor about medications or other methods to help you quit.

 Learn stress management techniques to help you deal with stress in your home and work life.

Spirituality:

 Pray for fast recovery and healing

 GORDON’S 11 FUNCTIONAL HEALTH PATTERNS

1. HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN

Before:
The patient believed that he was healthy and that he was “mas himsug pa sa
kabaw” as verbalized by the patient. He does not use any illicit drugs but
admitted that he drinks alcoholic beverages almost daily and smokes around 30
packs of cigarettes per year. He also said that he had no previous
hospitalizations prior to the accident. He usually does not seek consult whenever
he experiences illnesses and just treats it with home remedies or go to a quack
doctor.

During:
The patient thinks that it will be very hard for him to recover but he is still
hopeful despite his condition. He says that he tries his best to follow the
instructions and health teachings of the physician and the nurses for him to
recover sooner.

2. NUTRITION-METABOLIC PATTERN

Before:
The patient had no problems with swallowing and appetite. He used to eat three
meals in a day with snacks in between meals. He used to eat mainly vegetables
and fish and sometimes, poultry. He also took vitamins as his dietary
supplement. His typical fluid intake is about 6-8 glasses in a day.

During:
The patient has no dietary restrictions and has maintained his appetite with no
difficulty in swallowing. He still eats three meals and maintains hydration all
throughout the day though it is only limited to 1 litre per day.

3. ELIMINATION PATTERN

Before:
The patient used to defecate every day with no difficulty or discomfort and he
does not use any laxatives. He also had no difficulty or discomfort upon
urination. His urine is light yellow in colour and he urinates at least four times in
a day with no abnormal discharges.

During:
The patient verbalized that “makalibang ra man ko ma’am” because he has
laxative medications. The patient wears a diaper and has no pain upon urination.

4. ACTIVITY-EXERCISE PATTERN

Before:
The patient used to jog as his form of exercise. He used to keep himself active
during the day working as a farmer and also likes to fix things at home. He had
no breathing problem during activities and can perform ADLs even without
assistance.
 During:
The patient has limited range of motion since he has left-sided weakness but can
still do active ROM exercises since he can still move all of his extremities. He can
also sit up on bed from time to time but the patient cannot perform ADLs
properly and needs assistance.

5. SLEEP-REST PATTERN

Before:
The patient usually sleeps around 7:00 pm since they live in the province and
sometimes he wakes up in the middle of the night. He then has difficulty
sleeping but after a few hours, he goes back to sleep and wakes up at 7:00 am.
He does not use any sleeping aids. Upon waking in the morning he feels well
rested.

During:
The patient has difficulty sleeping since he is not used to the noise and the
disturbances in the hospital. He said that he just take naps throughout the day
and sometimes does not feel well rested.

6. COGNITIVE-PERCEPTUAL PATTERN

The patient is oriented to time, place, and person. He has no difficulty in talking
and constructing sentences and has not experienced any loss of memory.

7. SELF-PERCEPTION-SELF-CONCEPT PATTERN

Before:
The patient was satisfied with his body image; he said that there was nothing he
couldn’t do because he was healthy. He was proud that he was able to provide
for his family.

During:
The patient feels sad knowing his condition is not easy to deal with; he does not
like to see himself as helpless and is hoping for his recovery.

8. ROLE-RELATIONSHIPS PATTERN

Before:
The patient was the provider of the family and is the father of four children. He
is the decision maker in the household, and is well loved by the family.

During:
The patient’s family is still very supportive and now with the patient’s condition,
he is unable to provide for the family. So, his eldest who currently works as a
welder is the breadwinner since the wife is the watcher of the patient.

9. SEXUALITY-REPRODUCTIVE PATTERN

Before:
 The patient had no problems with libido, erectile dysfunction and infertility. He
was circumcised at the age of eleven.

During:
The patient is no longer sexually active because of his condition.

10. COPING-STRESS TOLERANCE PATTERN

Before:
Whenever the patient has problems or is stressed, he has his family to support
him and he can freely express his concerns to them. He also said that sometimes
he just wants to sleep because he feels better that way and he can think more
clearly after.

During:
The patient still has his family for support and just sleeps whenever he feels like
it since he can’t do much.

11. VALUES-BELIEFS PATTERN

Before:
The patient is a Catholic and believes in the power of prayer. He also believes in
quack doctors.

During:
He believes that he is being punished by God because of his misdeeds, he said
that he prays even harder now that he has been admitted, he mainly prays for
his recovery.